By all accounts, Scott Gottlieb, the Trump appointed director of the FDA is doing a good job.
Vox points out, he has announced substantial FDA moves to reduce cigarette consumption and is committed to improving competition in generic drugs.
However, he gave a recent speech at the National Food Policy Conference on “Reducing the Burden of Chronic Disease” which indicates he is misinformed on crucial aspects of nutritional science.
Gottlieb indicated he wanted the FDA to play a bigger role in guiding Americans to eat a healthier diet to reduce the burden of chronic disease.
To facilitate this he is looking to define what foods are “healthy”:
We’re keeping all these considerations in mind as we pursue rulemaking to update the definition of “healthy” so it’s based on nutrition criteria and food considerations that are more up-to-date than those being used for the current definition….
Once updating the definition, Gottlieb wants to label food as “healthy” In a way that makes it easier for consumers to understand:
To address this, we’ve had discussions about whether there should be a standard icon or symbol for the word “healthy” that everyone could use on food packages.
Gottlieb goes on to bemoan a focus on nutrients rather than foods but in the very next sentence recommends a food, dairy, in a form that has one important nutrient stripped from it-fat.
Traditionally, we’ve focused primarily on the nutrients contained in food in considering what is healthy. But people eat foods, not nutrients.
This is why we’re asking the important question of whether a modernized definition of “healthy” should go beyond nutrients to better reflect dietary patterns and food groups, like whole grains, low fat dairy, fruits and vegetables and healthy oils?
Obviously, the first step in getting Americans to eat healthier is to make sure you are doling out the correct advise and in his speech Dr. Gottlieb indicates he has bought into long-standing fundamental errors. I wrote him the following letter hoping to correct these errors.
Dear Dr. Gottlieb,
Congratulations on your recent appointment as FDA director and kudos for your fine work to date. I read your recent comments on developing an updated definition of “healthy” and the importance of conveying that information to American consumers I applaud your efforts in this area as well as your ongoing efforts to limit cigarette smoking and improve generic competition.
I am fine with guiding consumers to healthy foods but I beg of you, let this determination of what is healthy be guided by the actual science, not prior dogma.
In your recent speech you indicate that Americans are not consuming enough dairy and you recommend low-fat dairy which implies that you and the FDA believe that scientific studies have demonstrated that dairy fat is unhealthy.
Five years ago I, too , thought dairy fat was unhealthy and recommended my patients avoid butter, full-fat yogurt and cheese. However, when challenged on this belief, I reviewed the scientific literature on dairy fat and cardiovascular disease.
It turns out when objectively analyzed (as I have written about here and here ) there is no scientific evidence that supports the concept that dairy processed to remove dairy fat is healthier than the original unadulterated product.
In fact, evidence suggests full fat dairy reduces central obesity, diabetes, cardiovascular disease and atherosclerosis in general.
As a result of misguided recommendations to avoid dairy fat, it is virtually impossible in most grocery stores to find full fat yogurt or milk. The vast majority of the dairy aisle is devoted to various low or non fat concoctions which have had loads of sugar and chemicals added and are arguably worse than a Snickers bar.
Dr. Gottlieb ,I am not cherry-picking the data here or relying on out of date studies. I’ve reviewed everything I can find on this issue and reviewed it without bias. Evidence continues to accumulate supporting the healthiness of full fat dairy.
For example, here’s a 2018 review from researchers totally unaffiliated with the dairy industry which asks the question “Dairy Fats and Cardiovascular Disease: Do We Really Need to Be Concerned?”
After a exhaustive review they conclude the answer is no.
recent research and meta-analyses have demonstrated the benefits of full-fat dairy consumption, based on higher bioavailability of high-value nutrients and anti-inflammatory properties. … In general, evidence suggests that milk has a neutral effect on cardiovascular outcomes but fermented dairy products, such as yoghurt, kefir and cheese may have a positive or neutral effect.
Flawed Reasons for Low Fat Dairy Recommendations
As I have written previously, I believe there are three reasons for the failure of major nutritional recommendations such as the 2015 Dietary Guidelines For Americans to correct previously flawed advice to choose non or low-fat dairy over full fat:
1. In few randomized dietary studies showing benefits of a particular diet over another, non fat or low fat dairy was recommended along with a portfolio of other healthy dietary changes.
The overall benefit of the superior diet had nothing to do with lowering the dairy fat but was due to multiple other changes.
2. The dairy industry has no motivation to promote full fat dairy. In fact, they do better financially when they can take the fat out of milk and sell it for other purposes such as butter, cheese, and cream. (Please read my interview with a plastic surgeon dairy farmer on the skim milk scam here.)
3. Saturated fat is still mistakenly being treated as a monolithic nutritional element. Although dairy fat is mostly saturated, the individual saturated fats vary widely in their effects on atherogenic lipids and atherosclerosis. In addition, the nature of the saturated fat changes depending on the diet of the cow.
4. Since authorities have been making this low fat dairy recommendation for so long they are extremely reluctant to reverse their advice. It lowers their credibility.
There Is No Scientific Consensus On What Constitutes A Healthy Oil
Finallly, Dr. Gottlieb, I would like to briefly point out that there is considerable ongoing scientific debate about what constitutes a “healthy oil.”
I summarized this last year on a post on coconut oil (which I fear you will also pronounce “unhealthy”).
In many respects, the vilification of coconut oil by federal dietary guidelines and the AHA resembles the inappropriate attack on dairy fat and is emblematic of the whole misguided war on dietary fat. In fact, the new AHA advisory after singling out coconut oil goes on to cherry-pick the data on dairy fat and cardiovascular disease in order to support their faulty recommendations for choosing low or nonfat dairy.
Canola and corn oil, the products of extensive factory processing techniques, contain mostly mono or polyunsaturated fats which have been deemed “heart-healthy” on the flimsiest of evidence.
The most recent data we have on replacing saturated fat in the diet with polyunsaturated fat comes from the Minnesota Coronary Experiment performed from 1968 to 1973, but published in 2016 in the BMJ.
Data from this study, which substituted liquid corn oil in place of the usual hospital cooking fats, replaced corn oil margarine for butter and added corn oil to numerous food items, showed no overall benefit in reducing mortality. In fact, individuals over age 65 were more likely to die from cardiovascular disease if they got the corn oil diet.
So, Dr. Gottlieb, please continue your efforts to make Americans healthier but make sure the current scientific evidence actually supports your recommendations. Keep in mind, the disastrous public health experiments of previous decades.
N.B. Some of my posts on dairy fat are below.
Dairy Fat Makes You Thinner
The Skim Milk Scam
More Evidence That Diary Fat is associated with a lower risk of heart disease
What happens to cholesterol levels when you switch to low or non fat dairy?
Dietary Guidelines 2015: Why Lift Fat and cholesterol limits but still promote low fat dairy?
In defense of real cheese.
h/t to the always excellent Conscien Health for bringing Gottlieb’s speech to my attention.
Credit for the featured image of dairy cows from the wonderful Trader’s Point Creamery